New Grads in Specialty areas

  1. I would like to hear some thoughts on new grads working in ICUs or ERs right out of school. Our small hospital is resorting to hiring new grads and it scares me. I have worked in Med/Surg for over 25 years and I have precepted many new RNs to work on the Med/Surg units. It takes most of them more than two or three years to feel really confident at the bedside making sound decisions.I had a experience getting a report from a new grad ER nurse who I coached through the assessment.She said to me that I asked a lot of questions.What kind of preparations are these new grads getting to work in specialty areas?I shiver at the thought of being a patient there or anyone from my family.
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  2. 13 Comments

  3. by   delirium
    If you do a search, you'll find this has been discussed to death.

    Barring that, my input is that it greatly depends on both the quality of the new grad and the quality of the orientation/preceptorship program of the unit.
  4. by   UVaRN2Be
    Hi
    I was just accepted in the mentorship program (for new grads) into the NICU. I have questioned myself more times than I can count about my ability to do the job that needs to be done in an ICU. I am excited and I am scared. This is where I want to start. In order to do the best I can and do justice to the neonates and their families I intend upon studying and learning everything I can prior to my preceptorship in June.
    I carry a 4.0 in school, work fulltime, and raise 4 children. I know that doesn't mean much but I am extremely motivated and understand the grave nature of the ICU. Will I be comfortable/all knowing the first day I walk in? H@!! NO. The first month... same answer. I will check and double check myself. I don't know anything. Basically I see myself as, what is the word, ignorant. I will have a preceptor for 6 months, which I intend to use constantly. I am not afraid to ask questions or say I don't know something.
    I do understand your fear Daisy. I have inquired about this myself. I have asked nurses I work with what their opinions were (being as they know me and my ability) and I have asked here. After careful consideration I feel this is a good choice for me and utmostly for the neonates.
  5. by   fergus51
    Our hospital has taken a few new grads in ICU and ER in the last 2 years. These were students with extra specialty courses under their belts, who had done at least 2 months of their preceptorship on the unit. Some also had previous experience that helped (I know at least one was a paramedic). Orientation consisted of 24 shifts with a preceptor and extra formal education in a classroom to learn some of the advanced skills. The orientation time was flexible so if they needed more they could have more. Only one washed out. I am good friends with ICUs manager and she said with that orientation, the new grads actually did better than med-surg nurses who had come to the units with the regular orientation. BUT- she stressed these were very special new grads. I would be very interested to know what kind of orientation or extra education your hospital is offering them.
  6. by   SmilingBluEyes
    I was one and I did fine.
  7. by   UVaRN2Be
    In the hospital I work, (been there 5 yrs in BMT) they offer a up to 6 month preceptorship for all new grads. This depends on where we are placed and what type of orientation we need. The mentors we work with assess us and then decide if it is appropriate to come off orientation. (However, in the NICU, we are on for the full 6 months. This makes me happy.)We are placed in a classroom for education in our field and the advanced skills we need.
  8. by   purplemania
    I manage a program for new grads and, although my personal philosophy is that everyone needs med-surg experience, in reality it comes down to the individual. If someone wants to be a good nurse, they will be.
  9. by   JedsMom
    Originally posted by SmilingBluEyes
    I was one and I did fine.
    Ditto
  10. by   fab4fan
    I am four-square against it...esp in the ED. New grads have nothing to draw on, few skills, and things in the ED run the gamut from earaches to codes.

    I'm not saying med-surg is less challenging (I did it, and have the ultimate respect for M/S nurses...I couldn't do it again). But you learn all kinds of diseases, learn how to prioritize, procedures galore...

    It's kind of like building a house without a foundation. I feel like I can say this because I speak from personal experience. I could have saved myself a world of grief if I'd just started on M/S first; after 18y in different specialties, I've seen other people go through the same difficulties.
  11. by   Sally_ICURN
    I did it too and without incident.

    I agree that it depends on the hospital's new grad policies. There is no way on God's green earth that I could have done it without knowing that I was, and still am after almost two years, NEVER alone. That there is always someone there to support/help/consult with regarding a patient issue. I'm still learning and expect to be for quite some time to come. I think that for highly motivated people who know exactly what they want to do, being able to choose is good for both the nurse (job staisfaction) and the facility (retention). But I really don't think it's for everyone...there were a couple of people in my nursing class that would just be too overwhelmed.

    ~Sally
  12. by   bagladyrn
    I think a big distinction here is the size of the facility. A small hospital would have neither adequate staffing to allow for the length of preceptorship/orientation necessary, nor the quantity of patients to allow for breadth of experience in a short time. I can't count the number of times in small hospitals I have seen orientees pulled off orientation to make up for staffing shortages - cheating the orientee and potentially compromising patient care.
    If you are a new grad looking to go directly into a specialty area, I'd advise looking for at least a medium sized facility and getting written guarantees as to length of orientation and policies on pulling orientees.
  13. by   fab4fan
    baglady: That is exactly what happens in my facility. Newbies get pulled off orientation and are told they have to work as staff b/c we are short.

    I still think it's a bad idea in the ED, where it can be chaos galore, rapid turnaround of pts...you are constantly adjusting to new pts with new needs. It can get overwhelming for veteran staff members, let alone a new grad.
  14. by   essarge
    I read this discussion with great interest. I am a nursing student but I am also an Ed Tech. I have learned a great deal while I have worked there and am confident that when I graduate that is where I want to be. The nurses are great, as are the docs. Any questions that I have had have been answered. I have learned meds, protocol, etc while I have been there. I also work trauma's when they come in (everything short of pushing/starting IVs and meds).

    Now, the other side of the coin would be to hire someone in the ER without any experience whatsoever. On this I agree that YES, they need to work in a more organized/structured area for orientation for possibly up to a year to "get their feet wet". I have seen new grads in the ER and feel very bad for the ones without any experience. They become the scapegoat and most leave after only a short period due to stress. There are those, however, that do fine....but they are few and far between.

    Just my 2 cents worth.

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